;e nanodrug form of paclitaxel was approved by the FDA for
the treatment of metastatic pancreatic cancer in September

2013. ;is FDA approval followed earlier approvals of this
nanotherapeutic for the treatment of patients with breast or
lung cancer. It was the result of clinical trials showing that the
nanodrug form of paclitaxel transformed the lives of many
patients, like Dr. Charles Haerter (who was featured in the

AACR Cancer Progress Report 2013 ( 5)), diagnosed with one of
the most deadly forms of cancer ( 75).

In the quest to prevent and cure cancer, these new
tools are used alongside those already in the clinician’s
armamentarium. ;us, most patients are treated with a
combination of surgery, radiotherapy, chemotherapy, and
immunotherapy (see Appendix Tables 1 and 2, p. 106). In
June 2014, the FDA approved a new use for the radioactive
diagnostic imaging agent technetium Tc 99m tilmanocept
(Lymphoseek) that will bene;t some patients with head and
neck cancer who are undergoing surgery. ;e agent can now
be used to help surgeons ;nd the sentinel lymph node(s) in
patients with head and neck cancer, limiting the need for
further surgery in patients with cancer-free lymph nodes and
potentially improving postsurgical treatment decisions.

;e following discussion focuses on recent FDA approvals
that are transforming lives by having an impact on clinical
care across the spectrum of cancer prevention, detection,
diagnosis, treatment, and continuing care. It also highlights
some advances across the continuum of clinical care that are
showing near-term promise.

Cancer Prevention, Detection, and Diagnosis

;e most e;ective ways to reduce the burden of cancer are
to prevent cancer from developing in the ;rst place and,
if cancer does develop, to detect it as early as possible. As
research provides new insights into the factors that increase
a person’s risk of developing cancer (see Figure 5, p. 15)
and the timing, sequence, and frequency of the genetic,
molecular, and cellular changes that drive cancer initiation
and development, we have been able to develop new ways
to prevent cancer onset or to detect a cancer and intervene
earlier in its progression. In some cases, strategies to detect
a cancer also provide key information for diagnosis.

HPV Holds New Keys to Cancer Prevention

Almost all cases of cervical cancer are attributable topersistent cervical infection with certain strains of HPV( 42) (see Figure 7, see p. 23). Over time, this knowledgeenabled two approaches for cervical cancer prevention andearly detection: the development of vaccines that preventinfection with some cancer-causing strains of HPV and thedevelopment of a clinical test for detecting cancer-causingHPV strains (see Figure 11, p. 49). Several recent advancescould accelerate the pace of progress against cervicalcancer, which a;ects more than 500,000 women each yearworldwide ( 6) (see sidebar on Recent Advances in CervicalCancer Prevention and Early Detection, p. 49). Given that asubstantial proportion of vulvar, vaginal, penile, and analcancers, as well as some head and neck cancers—like thestage IV throat cancer that Robert (Bob) Margolis (see p. 50)was diagnosed with in 2007—are also caused by HPV, theseadvances may have broader implications for reducing theglobal burden of cancer.

;e two HPV vaccines currently approved by the FDA
protect against infection with just two cancer-causing
strains of HPV, HPV16 and HPV18. Although these are the
two most common cervical cancer-causing HPV strains
( 44), researchers have been working to develop vaccines
that protect against a greater number of the cancer-causing
HPV strains. Recent results indicate that one vaccine that
protects against seven cancer-causing HPV strains (HPV16,
- 18, - 31, - 33, - 45, - 52, and - 58) can prevent precancerous
cervical abnormalities caused by these strains ( 76).

;e proportion of cervical cancer cases caused by individual
HPV strains varies in di;erent regions of the world and
among di;erent segments of a given population. For
example, HPV16 and HPV18 account for more cases in
Europe, North America, and Australia compared with
Africa, Asia, and South/Central America ( 79), and for more
cases among non-Hispanic white women in the United
States compared with black and Hispanic women ( 80).

;us, the HPV vaccine that protects against nine cancer-causing HPV strains may particularly bene;t women
from racial and ethnic minorities and those living in less
developed nations. It may also reduce the burden of other
HPV-related cancers, which are frequently attributable to
cancer-causing strains other than HPV16 and HPV18 ( 44).

In the United States, it is recommended that individuals
receive three doses of either of the FDA-approved HPV
vaccines to best ensure that they are protected against
infection with HPV16 and HPV18. However, recent research
has shown that two doses of vaccine can generate HPV16-
and HPV18-targeted immune responses comparable to
those generated by three doses ( 77, 78). On the basis of these
results, the European Commission decided to approve the
marketing of a two-dose Gardasil schedule in April 2014

( 81). If long-term studies con;rm that two vaccine doses
provide protection against cervical cancer, it could mean
that individuals who failed to complete the three-dose